**12. Conclusion**

Dupuytren's disease is a unique fibroproliferative disorder of palmar fascia likely resulting from a complex interplay of genetic and environmental factors. Despite extensive research, its etiology remains unclear and treatment methods remain palliative. Observation is an acceptable form of treatment for mild disease and patients with low functional status. Collagenase injections and percutaneous fasciectomy are becoming more common as an initial treatment method for patients with isolated disease and a palpable cord. Surgical indications typically include a flexion contracture of >30° at the MCP joint and 10–15° at the PIP joint but are also influenced by patients' functional goals. Limited fasciectomy is the preferred method of surgical treatment by most surgeons. However, there is insufficient high quality evidence comparing different methods of treatment. In general, starting with a less invasive treatment is a reasonable approach; the recurrence rate may be higher, but patients will benefit from a quicker rehabilitation and a lower complication rate. Limited fasciectomy can then be reserved for more severe disease, initial treatment failures, or recurrence. PIP contractures, however, may benefit from earlier intervention due to their impact on function, increased likelihood of incomplete correction, and higher recurrence rate. Overall, surgery is an effective treatment for Dupuytren's contractures but complications can occur especially related to wound healing, and many patients experience recurrence. Further research is still needed to compare treatment modalities and determine appropriate indications.

Universel Hebdomadaire de Medecine et de Chirurgie Pratiques et des institutions medi-

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## **Author details**

Jeremiah D. Johnson, Colin Pavano and Craig Rodner\*

\*Address all correspondence to: rodner@uchc.edu

Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
